Combined treatments improve inoperable cervical cancer outcomes

Providing both chemotherapy and radiation therapy to women with locally advanced cervical cancer improves their chances of survival, according to a new report from the Cochrane Collaboration of London.

A comparison of five-year survival outcomes of 3,452 women participating in 13 clinical trials that compared chemoradiotherapy versus the same radiotherapy treatment used without chemotherapy revealed a 6% improvement in the group that received the combined treatment. An absolute improvement of 19% five years after treatment was also identified in two clinical trials in which additional chemotherapy treatments followed the combined chemoradiotherapy.

Cervical cancer is the second most common cancer affecting women globally, and it's the primary cancer affecting women living in sub-Saharan Africa, Central America, and south-central Asia.

Most of the total of 18 clinical trials conducted in 11 countries that were analyzed also reported that a larger percentage of patients receiving the combined treatment had longer disease-free outcomes as well.

The meta-analysis reviewed all relevant clinical trials with outcomes published in peer review journals, or with outcomes that were not published but were presented at professional conferences between January 1994 and October 2009. The resulting report was published in the Cochrane Database of Systematic Reviews (2010, Issue 1).

In 1999, the National Cancer Institute (NCI) in Bethesda, MD, issued new guidelines recommending that concomitant platinum-based chemotherapy and radiation therapy should be considered for treating cervical cancer instead of radiation therapy alone. The 18 clinical trials analyzed by lead author Claire Vale of the Medical Research Council Clinical Trials Unit in London included both platinum-based and nonplatinum-based drugs, and use of both types of drugs showed benefit to patients.

Vale reported that the effect of chemoradiotherapy appeared to be consistent across patient subgroups defined by age, histology, grade, or pelvic node involvement. However, the researchers identified a possible decreasing relative effect of chemoradiotherapy on survival with increasing tumor stage.

The treatment regimen generated serious hematological toxicity, but this could not be accurately analyzed due to differences in data reported in the clinical trials, the researchers noted. More serious gastrointestinal toxicities were reported in the trials using platinum-based chemoradiotherapy compared to the trials using nonplatinum-based drugs. There were inadequate data to assess whether serious late toxicity was affected by type of treatment, according to Vale.

After completing the study, the authors identified two clinical trials conducted in India that met the meta-analysis inclusion criteria. When the results are reported for both of these, the findings of this study will be updated.

By Cynthia E. Keen staff writer
January 22, 2010

Related Reading

More intense hyperthermia better treats cervical cancer, July 15, 2009

PET/CT shows its worth in cervical carcinoma, January 18, 2008

Toxicity levels with gynecologic chemoradiation deemed acceptable, November 28, 2007

Triple modality approach effective against cervical cancer, August 31, 2005

Copyright © 2010

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